How Much Water Should I Drink Each Day?

The average human body is more than 60% water. It comprises about two-thirds of your brain and heart, 83% of your lungs, 64% of your skin and even 31% of your bones. It’s involved in almost every process that keeps you alive. So, if you’ve joined the water-drinking craze, you’re doing yourself a big favor.

“Water is essential for your body’s survival,” says Crystal Scott, registered dietitian-nutritionist with Top Nutrition Coaching. “It helps regulate your temperature, transports nutrients, removes waste, lubricates your joints and tissues, and it also plays a crucial role in maintaining the delicate balance of electrolytes and fluids in your body.”

You lose water when you breathe, sweat, urinate and metabolize food and drink into energy, explains Fortune’s recent article, “It’s not 8 glasses a day anymore. Here’s how much water you should drink each day.”

If you don’t replace that fluid, your health can go downhill quickly. Without water, you’ll die in only a few days. There are simply too many systems that depend on it.

“It’s the starter when looking at any form of change or issues with your nutrition or your lifestyle—assess water intake first and foremost,” says Scott. “It helps with fullness cues, it can improve cognitive function, mood, physical performance, and can prevent health problems like constipation, kidney stones, and urinary tract infections. It’s one of the foundational building blocks.”

The common rule of thumb you’ve likely heard is the 8×8 rule: Drink eight 8-ounce cups of water daily. If you’re achieving that, you’re doing well but may benefit from some adjustments. Your intake recommendation may also vary based on life circumstances. For example, if you live in a hot and humid climate, get a lot of physical activity, are pregnant, or are breastfeeding, you may need more water daily than the average adult. Your doctor can help guide you.

The National Academy of Science, Engineering, and Medicine recommends an average daily water intake of about 125 ounces for men and about 91 ounces for women. If you’re not getting exactly that amount every day, you’re probably still close or even over because you also get water from food. While it’s rare, it is possible to drink too much water, a condition known as hyponatremia. It occurs when water in your system overwhelms your kidneys, which can’t keep up with a normal filtration rate.

However, for most of us, the bigger issue is getting enough water. While it’s helpful to keep tabs on actual ounces, your body is the best indicator of whether you’re well-hydrated. Your body will show certain signs when you don’t get enough water.

“Urine color is a really great indicator of hydration status,” says Scott. You’re golden if your toilet water is pale yellow or clear after you pee. Dark yellow or amber-colored urine is a sign your body needs fluids. Headaches, migraines, bad sleep, constipation, dizziness and feeling light-headed or confused can also be signs of dehydration.

Reference: Fortune (May 6, 2023) “It’s not 8 glasses a day anymore. Here’s how much water you should drink each day”

Can My Barber Help Me Live Longer?

Up to 1 in 5 Americans will develop skin cancer in their lifetime, notes the American Academy of Dermatology.

What’s more, the rates of melanoma, the deadliest form of skin cancer, have increased in recent decades, reports Livestrong’s recent article, “Want to Age Well? Do This the Next Time You Get a Haircut.”

If skin cancer is detected at an early stage, when the cancer cells remain localized to the skin, it can often be cured with a simple procedure like a minor skin surgery or even a prescription cream.

That’s where your hairdresser comes in. In addition to cutting your locks, they can help spot growths on your scalp, ears, or neck.

Your scalp, neck, and ears get extensive exposure to the sun’s UV rays every day. That puts them at high risk for potential skin cancers. However, it’s hard to see these parts of your own body, so a new or unusual growth might go unnoticed for several months.

Hairdressers see our scalps most closely and regularly. They can be the first to spot something growing on these sites.

Since they spend so much time looking at scalps, ears, and necks each day, they often have a keen sense about whether a growth seems out of the ordinary. You can bring up the topic casually at your next haircut.

Before sitting down, let your hairdresser know you’re trying to be more proactive about your skin health. Ask them to let you know if they notice any unusual moles or spots while they wash and cut your hair.

Remember that your hairdresser isn’t a skin expert. However, think of them as an additional tool in your skin cancer prevention tactics arsenal.

They aren’t a substitute for good skin-care habits like wearing sunscreen (and sun-protective clothing) and seeing a dermatologist for an annual skin check.

Reference: Livestrong (June 25, 2023) “Want to Age Well? Do This the Next Time You Get a Haircut”

What Should I Know About Stroke Recovery?

A stroke is a serious medical emergency that happens when blood flow is deficient to an area of the brain or bleeding in the brain. Sometimes, direct stroke intervention is necessary. This may include:

Blood thinners given intravenously (IV) for an ischemic stroke;
Direct injection of blood thinners into a blood clot for certain types of ischemic strokes;
Thrombectomy, where a thin tube (catheter) is threaded through blood vessels to a clot in the brain, and the clot is mechanically removed;
Surgical intervention for removal of blood for a hemorrhagic stroke; and
A craniotomy removes a small area of the skull to relieve severe edema (swelling).

VeryWell Health’s recent article, “Everything You Should Know About Stroke,” explains that close monitoring of neurological functioning, fluid and electrolyte concentration, blood pressure and blood glucose is needed in the first few days after a stroke. Brain damage from a stroke may sometimes cause a seizure, necessitating treatment with antiepileptic medication.

After stabilization, recovery can start, but note that recovery after a stroke is often gradual. Some people fully recover, but most have some impairment after a stroke.

Immediate medical care and consistent therapy can improve long-term outcomes. Patience throughout recovery is important because improvement doesn’t always adhere to a smooth and steady path.

Sometimes, complications can be prevented by taking proactive measures. Choking or pneumonia, possibly due to difficulty swallowing, is an especially concerning risk. Weakness and sensory changes can increase the chances of bedsores and blood clots. Weakness and vision changes may lead to falling after a stroke.

Rehabilitation should be customized to specific deficits that happen after a stroke. For example, many people require physical therapy to help with improving muscle control and strength. Speech and swallow therapy is crucial to avoid choking and aspiration pneumonia.

Recovery can frequently be slow over the next few weeks. For some, recovery continues for up to a year.

Reference: VeryWell Health (Feb. 27, 2023) “Everything You Should Know About Stroke”

Planning for Aging without Family Caregivers

As they age, many people have diminished capacity and cannot care for themselves. They may no longer be able to walk or drive easily and can experience difficulty with basic activities like shopping, cooking, cleaning, and arranging important doctor’s appointments. Traditionally, the adult children of the elderly have been caregivers, monitoring their parent’s health and overseeing financial decisions, reports the article “ICYMI | Getting Older Without Family” from CPA Journal. Parents without children, or those without good relationships with children, need to make alternative arrangements. An experienced estate planning attorney can help.

Living arrangements. Most people prefer to remain in their homes, in familiar surroundings. This may work if the home can be made elderly-friendly and a support system is implemented. A home alert system or automatic daily call-ins can be arranged through friends or local police departments. If remaining at home is not viable, an assisted living facility or continuing care retirement community may be the next best option if the cost can be managed.

Healthcare matters. Having a healthcare advocate is advisable for everyone. So is a Healthcare Proxy, or Healthcare Power of Attorney, which designates a person to act as the patient’s agent in making decisions. A Living Will details the kind of treatment a person does or doesn’t want if they cannot express their wishes.

Finances. As they age, people may find managing their finances too difficult. There are several options, depending on the degree of help needed. A CPA or financial advisor may be able to provide money management services. Banks may permit an account owner to add the name of another person with signatory authority—they can sign checks but are not an account owner. A representative can be named to receive Social Security funds, and they must file reports with the Social Security Administration to show how the funds have been used.

Durable Power of Attorney. This is the most critical planning tool for seniors and others. This designates an agent to act on behalf of the elderly person in financial matters. It can be created to define the scope of the agent’s authority and remains effective when the elderly person becomes incapacitated. It must be created and executed when the person has the requisite capacity.

Trusts. A trust holds legal title to an older adult’s assets, including bank accounts, brokerage accounts, or their home. The trust is managed by a trustee for the benefit of the elderly person. There are several different trusts available, depending on the situation. A Living Trust can be used while the person can still manage assets and act as their trustee, retaining the right to revoke the trust and regain title to assets. If the person becomes incapacitated, another person named the successor or co-trustee takes over, assuming the trust has not been revoked. The trustee could be a trusted professional, a relative, or a bank trust department, which may be expensive but is a good option for an aging person with significant resources but no individual to serve as the trustee.

Instead of a living trust, the elderly person may set up an Irrevocable Lifetime Trust for Medicaid and long-term care planning purposes wherein someone else is designated a trustee from the start.

Aging alone may seem like a daunting experience, but with the right planning and support network in place, it can be rewarding, enjoyable, and safe.

Reference: CPA Journal (July 2023) “ICYMI | Getting Older Without Family”

What Is Hypertensive Chronic Kidney Disease and Glomerulonephritis?

Unlike an acute kidney injury (AKI), where the loss of kidney function may be reversible, chronic kidney disease is “progressive.” That means it gets worse over time. The damage to your kidneys causes scars and is permanent. Among the diseases that can cause CKD are diabetes, hypertension, glomerulonephritis and polycystic kidney disease. This post looks at glomerulonephritis.

Very Well Health’s recent article, “Causes and Risk Factors of Chronic Kidney Disease,” explains that glomerulonephritis is a group of diseases that cause inflammation of the glomeruli and nephrons. Glomerulonephritis usually affects both kidneys and can happen alone or as part of another disease.

While it’s often hard to pinpoint what triggered the inflammatory response, the causes can be broadly broken down as follows:

Focal segmental glomerulosclerosis, a group of diseases that cause the selective scarring of glomeruli
Autoimmune disorders, which either damage the kidneys directly (IgA nephropathy or granulomatosis with polyangiitis) or trigger whole-body inflammation that indirectly damages the kidneys (such as with lupus); and
Inherited disorders like polycystic kidney disease, which causes the formation of cysts in the kidneys; Alport syndrome, which damages the blood vessels of the kidneys; or Goodpasture syndrome, which damages kidney membranes.

In some cases, the cause of glomerulonephritis is never found. There are also other, less common causes of CKD in adults and children. They include the following:

Heavy metal poisoning, including lead poisoning;
Hemolytic-uremic syndrome, in which ruptured red blood cells block renal filters (occurs exclusively in children);
Hepatitis B and hepatitis C, both of which are associated with glomerulonephritis and renal vascular inflammation;
Interstitial nephritis, inflammation of the kidney tubules often related to the long-term use of analgesics or antibiotics;
Pyelonephritis, a bacterial infection of the kidneys;
Prolonged urinary tract obstruction, including an enlarged prostate, kidney stones and certain cancers;
Recurrent kidney infections; and
Reflux nephropathy, the backing-up of urine into the bladder.

In addition to known causes, CKD can often be idiopathic, meaning the cause can’t be found.

Reference: Very Well Health (July 25, 2021) “Causes and Risk Factors of Chronic Kidney Disease”

What’s the Latest on VA’s Coverage of New Alzheimer’s Drug?

The VA has announced that it will cover Leqembi, a monoclonal antibody therapy made by pharmaceutical companies Eisai and Biogen, for veterans in the disease’s early stages. This makes the VA the first and largest health program in the country to endorse the treatment, reports’ military.com in its recent article entitled, “VA to Cover New Drug for Early Stage Alzheimer’s Disease.”

In January, the FDA granted accelerated approval for Leqembi, also known as lecanemab, when research showed that the medication slowed the physical and mental decline in some patients with early Alzheimer’s by as much as 27%. Although research is ongoing on the treatment’s effectiveness, the drug is among the first to show that it reduces beta amyloid — the toxic protein that contributes to the development of Alzheimer’s — in the brain.

“This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer’s instead of only treating the symptoms of the disease,” said Dr. Billy Dunn, director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, during the accelerated approval announcement.

The VA treats about 168,000 veterans with Alzheimer’s, some of whom are in the early stages. Leqembi has an estimated cost of $26,500 a year, and a two-milliliter dose at the VA will cost the department $194.63. A five-milliliter dose will cost $486.57, according to the department’s National Acquisition Center Contract Catalog.

According to VA Press Secretary Terrence Hayes, the drug will be available only at the request of a provider to vets who “most closely align with” patients who meet the selection criteria for clinical trials. This means that the VA patients must meet the same demographic and health history standards as those studied by the manufacturers.

“Each dose of the medication administered for each patient will be tracked and monitored for safety and appropriateness of use, in real-time, by VA’s Center for Medication Safety,” Hayes said in an email to Military.com. “VA will continue to monitor the clinical evidence and safety data for this agent and adjust the criteria for use as appropriate. VA also has capabilities and safeguards in place that are very different from the private sector, such as the ability to conduct real-time medication-use evaluations that will allow for continued safe use of the medication.”

Leqembi is approved for use only in patients with early Alzheimer’s with a “confirmed presence,” via a brain scan, of beta amyloid.

Reference: military.com (March 14, 2023) “VA to Cover New Drug for Early Stage Alzheimer’s Disease”

Why Do I Need a Will?

Perhaps getting hit by a cement truck is too blunt for some, but unexpected things happen all the time. An estate plan, including a will and other important documents, is good preparation, especially for caregivers of people with special needs. A recent article from Forbes titled “Where There is a Will, There is a Way” explains the steps everyone, especially caregivers, need to follow.

Creating a last will and testament

This is the foundation of an estate plan. Without a will, the court will distribute assets to children equally. If a disabled person receiving government benefits receives an inheritance, they will become ineligible and lose access to services. The court will also assign guardianship to minors or disabled individuals, if there is no will. A will, in tandem with proper estate planning, ensures protection for an individual with special needs, including naming a guardian of your choice.

Having a General Durable Power of Attorney for Finances

A POA allows you to name a person you trust to manage finances, real estate property, investments, or any aspect of your life, if you become incapacitated. A POA should be created for your needs, so you may decide in advance what you do and do not want your agent to be able to do for you.

Creating a Durable Power of Attorney for Healthcare

This important legal document, paired with a HIPAA release form, allows someone of your choice to take charge of your healthcare, talk with healthcare providers and make decisions based on your expressed wishes. You may name more than one person for this role but doing so could make it harder if the two people don’t agree on your care.

Naming a Guardian

This is a critical step if you are a caretaker for a person who will likely be unable to manage their own affairs, even after attaining legal age. By naming a guardian in your will, you can select the people who will be in charge of your special needs family member or minor children. Without a guardian named in your will, the courts will make this decision.

Drafting a “Letter of Intent”

A letter of intent is a guide with important information only you know. It is especially important for caretakers. Explaining in detail your disabled individual’s preferences can make a huge difference in the quality of their lives when you are no longer available. What are their likes and likes, what people do they enjoy spending time with and what foods do they prefer, etc. If your children are minors, this letter is an opportunity to describe your preferences for how they should be raised, including religious preferences, vocational choices and even nighttime rituals.

Providing Financial Security

If your family includes a loved one with Special Needs, you can protect their ability to have funds for things not covered by government benefits through a Special Needs Trust. Your estate planning attorney will create an SNT with a trustee and a secondary trustee to oversee the funds and ensure that they are used for qualified expenses.

Reference: Forbes (July 6, 2022) “Where There is a Will, There is a Way,”

Is It Important for Physicians to Have an Estate Plan?

When the newly minted physician completes their residency and begins practicing, the last thing on their minds is getting their estate plan in order. Instead, they should make it a priority, according to a recent article titled “Physicians, get your estate in order or the court will do it instead” from Medical Economics. Physicians accumulate wealth to a greater degree and faster than most people. They are also in a profession with a higher likelihood of being sued than most. They need an estate plan.

Estate planning does more than distribute assets after death. It is also asset protection. An estate planning attorney helps physicians, dentists and other medical professionals protect their assets and their legacies.

Basic estate planning documents include a last will and testament, financial power of attorney and a medical power of attorney. However, the physician’s estate is complex and requires an attorney with experience in asset protection and business succession.

During the process of creating an estate plan, the physician will need to determine who they would want to serve as a guardian, if there are minor children and what they would want to occur if all of their beneficiaries were to predecease them. A list should be drafted with all assets, debts, including medical school loans, life insurance documents and retirement or pension accounts, including the names of beneficiaries.

The will is the center of the estate plan. It will require naming a person, typically a spouse, to be the executor: the person in charge of administering the estate. If the physician is not married, a trusted relative or friend can be named. There should also be a second person named, in case the first is unable to serve.

If the physician owns their practice, the estate plan should be augmented with a business succession plan. The will’s executor may need to oversee decisions regarding the sale of the practice. A trusted friend with no business acumen or knowledge of how a medical practice works may not be the best executor. These are all important considerations. Special considerations apply when the “business” is a professional practice, so do not make any moves without expert estate planning assistance.

The will only controls assets in the individual’s name. Assets owned jointly, or those with a beneficiary designation, are not governed by the will.

Without a will, the entire estate may need to go through probate, which is a lengthy and expensive process. For one family, their father’s lack of a will and secrecy took 18 months and cost $30,000 in legal fees for the estate to be settled.

Trusts are an option for protecting assets. By placing assets in trust, they are protected from creditors and provide control in complex family situations. The goal is to create a trust and fund it before any legal actions occur. Transferring assets after a lawsuit has begun or after a creditor has attached an asset could lead to a physician being charged with fraudulent conveyance—where assets are transferred for the sole purpose of avoiding paying creditors.

Estate planning is never a one-and-done event. If a doctor starts a family limited partnership to transfer wealth to the next generation but neglects to properly maintain the partnership, some or all of the funds may be vulnerable.

An estate plan needs to be reviewed every few years and certainly every time a major life event occurs, including marriage, divorce, birth, death, relocation, or a significant change in wealth.

When consulting with an experienced estate planning attorney, a doctor should ask about the potential benefits of revocable living trust planning to avoid probate, maintain privacy and streamline the administration of the estate upon incapacity or at death.

Reference: Medical Economics (Feb. 22, 2022) “Physicians, get your estate in order or the court will do it instead”

Who Is the Best Choice for Power of Attorney?

Picking a person to serve as your Power of Attorney is an extremely important part of your estate plan, although it is often treated like an afterthought once the will and trust documents are completed. Naming a POA needs to be given the same serious consideration as creating a will, as discussed in this recent article “Avoid powers of attorney mistakes” from Medical Economics.

Choosing the wrong person to act on your behalf as your Power of Attorney (POA) could lead to a host of unintended consequences, leading to financial disaster. If the same person has been named your POA for healthcare, you and your family could be looking at a double-disaster. What’s more, if the same person is also a beneficiary, the potential for conflict and self-dealing gets even worse.

The Power of Attorney is a fiduciary, meaning they are required to put your interests and the interest of the estate ahead of their own. To select a POA to manage your financial life, it should be someone who you trust will always put your interests first, is good at managing money and has a track record of being responsible. Spouses are typically chosen for POAs, but if your spouse is poor at money management, or if your marriage is new or on shaky ground, it may be better to consider an alternate person.

If the wrong person is named a POA, a self-dealing agent could change beneficiaries, redirect portfolio income to themselves, or completely undo your investment portfolio.

The person you name as a healthcare POA could protect the quality of your life and ensure that your remaining years are spent with good care and in comfort. However, the opposite could also occur. Your healthcare POA is responsible for arranging for your healthcare. If the healthcare POA is a beneficiary, could they hasten your demise by choosing a substandard nursing facility or failing to take you to medical appointments to get their inheritance? It has happened.

Most POAs, both healthcare and financial, are not evil characters like we see in the movies, but often incompetence alone can lead to a negative outcome.

How can you protect yourself? First, know what you are empowering your POAs to do. A boilerplate POA limits your ability to make decisions about who may do what tasks on your behalf. Work with your estate planning attorney to create a POA for your needs. Do you want one person to manage your day-to-day personal finances, while another is in charge of your investment portfolio? Perhaps you want a third person to be in charge of selling your home and distributing your personal possessions, if you have to move into a nursing home.

If someone, a family member, or a spouse, simply presents you with POA documents and demands you sign them, be suspicious. Your POA should be created by you and your estate planning attorney to achieve your wishes for care in case of incapacity.

Different grown children might do better with different tasks. If your trusted, beloved daughter is a nurse, she may be in a better position to manage your healthcare than another sibling. If you have two adult children who work together well and are respected and trusted, you might want to make them co-agents to take care of you.

Your estate planning attorney has seen all kinds of family situations concerning POAs for finances and healthcare. Ask their advice and don’t hesitate to share your concerns. They will be able to help you come up with a solution to protect you, your estate and your family.

Reference: Medical Economics (Feb. 3, 2022) “Avoid powers of attorney mistakes”

Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

How Much Water Should I Drink Each Day?

Can My Barber Help Me Live Longer?

What Should I Know About Stroke Recovery?

Planning for Aging without Family Caregivers

What Is Hypertensive Chronic Kidney Disease and Glomerulonephritis?

What’s the Latest on VA’s Coverage of New Alzheimer’s Drug?

Why Do I Need a Will?

Is It Important for Physicians to Have an Estate Plan?

Who Is the Best Choice for Power of Attorney?

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How Much Water Should I Drink Each Day?

Can My Barber Help Me Live Longer?

What Should I Know About Stroke Recovery?

Planning for Aging without Family Caregivers

What Is Hypertensive Chronic Kidney Disease and Glomerulonephritis?

What’s the Latest on VA’s Coverage of New Alzheimer’s Drug?

Why Do I Need a Will?

Is It Important for Physicians to Have an Estate Plan?

Who Is the Best Choice for Power of Attorney?

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